The Psychological Sequelae
of Abortion: Myths and Facts
A Symposium held on
May 31, Berne, Switzerland
Background to the Symposium
In March 2001, the Swiss National Council, the parliament's
largest chamber, voted to legalise abortion up to the 12 week
of pregnancy. Previous to this vote, abortion in Switzerland has
been regulated by the 1942 penal code. According to articles 118-121
of this code, abortion is a criminal offence unless it is done
by a doctor to save the woman's life or in order to avoid risk
of severe and lasting damage to the woman's health. Such danger
has to be confirmed in writing by a second doctor. Over the last
25 years, practice in abortion provision has, however, become
liberal in most parts of Switzerland, as 'health' has been interpreted
by doctors according the WHO definition, of not merely absence
of disease, but a state of well-being. There have been no successful
prosecutions for illegal abortion since 1988.
There have been several unsuccessful attempts to change the law
since 1942. A recent campaign, headed by the Working Group on
Pregnancy Termination, an alliance of women's groups, has however
been successful in its campaign for law reform. According to the
new legislation, abortion in the first 12 weeks of pregnancy (from
the first day of the last menstrual period) is to be allowed at
the request of the woman, who feels she is in a state of distress.
The doctor has to obtain informed consent, and provide her with
addresses of specialised counselling services. Abortion can be
performed in a hospital or authorised doctor's offices. After
12 weeks, abortion is to be allowed if, according to a doctor's
advice, it is necessary to avoid a severe danger to the physical
health of the woman or severe psychological stress.
The new law has been opposed, and the Christian Democratic People's
Party (CDP) has said it will attempt to force a referendum on
the issue. Groups opposed to abortion are collecting signatures
(100 000 are required) to ask for this referendum. During debate
about the new law, the CDP did propose a measure, which was rejected,
that would have required women to undergo 'independent counselling'
before having an abortion. CDP President Adalbert Durrer argued
that without such a clause, the law 'offered totally insufficient
protection' to 'unborn life' and that the decision to have an
abortion 'should not be considered by the woman alone'. Part of
the argument made by groups opposed to abortion, for their case
for a referendum, is that women suffer severe psychological damage
from abortion (a 'post-abortion syndrome') and that laws and counselling
should deter women from abortion. The referendum will probably
take place at the end of 2001.
In this context, a Symposium was organised to discuss research
about the psychological effects of abortion, and in particular
to consider the findings of studies about this issue. The Symposium
was supported by the Swiss Society of Psychiatry and Psychotherapy,
The Federation of Swiss Psychologists, The Swiss Association of
Psychotherapists, The Swiss Foundation for Sexual and Reproductive
Health, The Swiss Family Planning Society an the Swiss Society
for Public Health.
Summaries of papers covering research findings discussed at the
Symposium follow. To access the full text of a paper by Dr Ellie
Lee given at the Symposium, entitled 'The context of the development
of 'Post-Abortion Syndrome'' click here
A Regional Prospective Study of Psychical Sequelae to Legalized
Barnett, W., Freudenberg, N., and Wille R.
Fortshr. Neurol. Psychiat. 54 (1986) 106-118 (full paper is published
117 (45%) of the 263 women of German nationality who underwent socially
indicated abortions in the postal-code area 2300 (Kiel) in the first
quarter of 1982 were investigated before abortion as well as one
year later. As far as age, marital status and number of children
were concerned, these women did not differ significantly from the
One year later information was collected on the women's emotional
adjustment by means of a questionnaire concerning feelings of guilt
and loss, personal reports of adjustment process, and the investigator's
judgement. According to the findings, 79% of the women had adjusted
without any problems, 14% were still in a state of emotional imbalance,
7% were clearly impaired emotionally and in their everyday functioning
21% of the women who had adjustment problems, had already been more
depressive before the abortion. One year later, they were also more
depressive than the other women, more dissatisfied with their lives
in general and with their sex lives. They were in greater doubt
as to whether they had made the right decision, showed less inclination
to consider a further abortion and reported stronger post-abortive
feelings of guilt.
Significantly connected with later emotional difficulties were low
social class, a difficult financial situation, lack of intrapsychic
differentiation between sex and reproduction, no partner or negative
relation with partner and partner disagreements, particularly in
the case where the male partner was more in favour of abortion than
the woman. Statistically insignificant, although tendencially noticable,
were social isolation, non-employment and pre-pregnancy psychical
problems. Age, marital status, number of children, simultaneous
abortion/sterilisation, previous abortions, a broken home in the
patient's youth had no effect on emotional adjustment after abortion.
The common factor of all variables predicting post-abortive emotional
problems seems to be an external motivation for abortion together
with a greater ambivalence towards the pregnancy.
Sexuality, partner relations, and contraceptive practice after
termination of pregnancy.
Bianchi-Demicheli, F. et al.
Journal of Psychosomatic Obstetrics and Gynaecology (forthcoming)
The aim of this study was to determine the influence of termination
of pregnancy (TOP) on women's sexual well being, the couple and
In a prospective qualitative and quantitative study, 103 women undergoing
induced abortion by vacuum aspiration were interviewed before the
abortion and 6 months later. The interview was performed by means
of a questionnaire including open and closed questions, and two
psychological tests (Locke-Wallace and Horowitz). After TOP, the
majority of women did not report changes in their sexual behaviour
and satisfaction. Eighteen percent of women reported a decrease
in sexual desire and 17 percent orgasmic disorders. About one third
of women described psychosomatic symptoms, but a minority was traumatised
by the event. Ninety-eight per cent of the women were informed about,
and had practised contraception in the past; 69 per cent had actually
used some kind of contraception during the menstrual cycle that
had resulted in pregnancy (31 per cent had unprotected intercourse).
Six months later, 83 per cent practised contraception, and only
17 per cent did not. Fourteen out of 84 couples separated after
TOP (one out of six).
Six months after TOP, the large majority of women interviewed seemed
able to cope with TOP. A minority presented some persisting sexual
dysfunctions and/or some psychosomatic symptoms.
The Relationship of Abortion to Well-being: Do Race and Religion
Make a Difference?
Nancy Felipe Russo and Amy J. Dabul
Professional Psychology, Research and Practice, 1997, Vol. 28, No
Relationships of abortion and childbearing to well-being were examined
for 1,189 Black and 3,147 White women. Education, income, and having
a work role were positively and independently related to well-being
for all women. Abortion did not have an independent relationship
to well-being, regardless of race or religion, when well-being before
becoming pregnant was controlled. These findings suggest professional
psychologists should explore the origins of women's mental health
problems in experiences predating their experience of abortion,
and they can assist psychologists in working to ensure that mandated
scripts from 'informed consent' legislation do not misrepresent
Termination of Pregnancy and Psychiatric Morbidity
Anne C. Gilchrist, Philip C. Hannaford, Peter Frank and Clifford
British Journal of Psychiatry (1995), 167: 243-48
Background.We investigated whether reported psychiatric morbidity
was increased after termination of pregnancy compared with other
outcomes of an unplanned pregnancy.
Method.This was a prospective cohort study of 13 261 women
with an unplanned pregnancy. Psychiatric morbidity reported by GPs
after the conclusion of the pregnancy was compared in four groups:
women who had a termination of pregnancy (6410), women who did not
request a termination (6151), women who were refused a termination
(379), and women who changed their minds before the termination
was performed (321).
Results.Rates of total reported psychiatric disorder were
no higher after termination of pregnancy than after childbirth.
Women with a previous history of psychiatric illness were most at
risk of disorder after the end of their pregnancy, whatever its
outcome. Women without a previous history of psychosis had an apparently
lower risk of psychosis after termination than postpartum (relative
risk RR = 0.4, 95% confidence interval CI = 0.3-0.7), but rates
of psychosis leading to hospital admission were similar. In women
with no previous history of psychiatric illness, deliberate self-harm
(DSH) was more common in those who had a termination (RR 1.7, 95%
CI 1.1-2.6), or who were refused a termination (RR 2.9, 95% CI 1.3-6.3).
Conclusions. The findings on DSH are probably explicable
by confounding variables, such as adverse social factors, associated
both with the request for termination and with subsequent self-harm.
No overall increase in reported psychiatric morbidity was found